The federal government recently accused a New York doctor of partaking in a health care fraud scheme that spanned throughout the country. The alleged scheme involved prescriptions for a pain cream in exchange for illegal kickbacks from a pharmacy located in Oklahoma.
Ultimately, the physician chose to settle the allegations with the government. He faces reduced penalties in exchange for paying the government $172,072.
Three things physicians in New York can learn from this case include the following:
#1: Federal investigations are thorough.
Those who are the subject of a federal investigation should be prepared to become part of a very thorough examination of records and billing practices. The investigation in the case noted above resulted in an expansion that spanned state lines. Another government health care fraud investigation, discussed in a previous post available here, ultimately led to evidence that revealed the college admissions scandal involving some elite members of the Hollywood community.
The takeaway lesson: know that if you are the subject of such an investigation any skeletons kept in the practice’s closet will likely come out into the light of day.
#2: Reevaluate agreements and partnerships with other professionals.
These cases serve as a reminder to review your facility’s best practices. Analyze relationships that result in referrals to make sure they do not run afoul of applicable regulations and make changes as needed.
If not, the practice could find itself facing serious scrutiny because the government often closely analyzes relationships that result in financial gain.
#3: The government has eyes everywhere.
It is not uncommon for these investigations to start as the result of a tip from a whistleblower. Administration personnel and other medical professionals can contact government authorities and voice allegations of health care fraud.
Knowing these basics can help to reduce the risk of becoming the subject of a health care fraud investigation. However, investigations can happen to anyone. Those who are the subject of such an investigation can act to protect their interests by seeking legal counsel experienced in this niche area of the law.